Respiratory Tumours

Question 1

Where should a chest drain be placed?

Answer 1

5th intercostal space in the mid-axillary line

Question 2

Does lung cancer cause a transudate or an exudate

Answer 2

Exudate = pleurql effusions caused by changes to the local factors that influence the formation and absorption of pleural fluid

eg Malignancy,
infection etc

Question 3

What is the difference between a transudate and an exudate

Answer 3

Transudate =
Pprotein <30 g/L

Exudate= protein >30 g/L

Question 4

What nerve might be affected in a lung cancer causing hoarseness?

Answer 4

Recurrent laryngeal nerve

Question 5

Invasion of which nerve in lung cancer can cause dysphagia?

Answer 5

Phrenic nerve

Question 6

What hormone does small cell carcinoma produce?

Answer 6

ACTH

Question 7

What lung cancer is common in non-smokers?

Answer 7

Adenocarcinoma

Question 8

Which type of lung cancer is chemotherapy more effective against?

Answer 8

Small cell lung cancer

Question 9

If a lung cancer is located centrally on a CT scan, what is the best way to obtain tissue for histology?

Answer 9

Bronchoscopy

Question 10

If a lung cancer is located peripherally on a CT scan, what is the best way to obtain tissue for histology?

Answer 10

Percutaneous FNA/biopsy

Question 11

When should sputum cytology be used as a test for lung cancer?

Answer 11

In patients with large central lesions where bronchoscopy and other tests are unsafe

Question 12

Using the TNM system for non-small cell lung cancer staging, what is the most advanced tumour that can still be resected?

Answer 12

T3N1M0

(T3 occasionally may be resectable but T4 invades vital structures. N1 is ipsilateral hilar tumour spread and can still be resected)

Question 13

Where are the common sites for lung mets?

Answer 13

Liver, adrenal glands, bone and brain

Question 14

What investigation is performed in patients with symptoms suggestive of metastatic bone disease?

Answer 14

Bone scan

Question 15

Patients with Stage I or Stage II NSCLC and Stage I SCLC should be considered for curative surgery. True or false?

Answer 15

True

Question 16

Patients of which performance status are fit for surgery?

Answer 16

0, 1 & 2

Question 17

What makes a lung cancer patient inoperable?

Answer 17

• Stage III or stage IV lung cancer
• Poor respiratory reserve, i.e. poor FEV1
• Multiple co-morbidities making them a high risk surgical candidate
• WHO performance status 3 or 4

Question 18

Which of the following is chemotherapy not the first line treatment option for?

• Most cases of small cell lung cancer
• Stage II non-small cell lung cancer
• Stage IIIB non-small cell lung cancer
• Stage IV non-small cell lung cancer

Answer 18

Stage II non-small cell lung cancer

Stage I & II NSCLC can be resected, as can stage I SCLC

Question 19

Chemotherapy is generally not recommended in patients with what performance status?

Answer 19

3 or 4

Question 20

Radiotherapy is never curative in lung cancer. True or false?

Answer 20

Radiotherapy may be curative in some cases (mainly NCCLC)

Question 21

A patient with a pancoast tumour presents with unilateral miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face). What condition do they have?

Answer 21

Horner’s syndrome

Question 22

What is a pancoast tumour?

Answer 22

Cancers that begin at the apex of the lung which can invade the brachial plexus

Question 23

What symptoms apart from Horner’s syndrome can a pancoast tumour cause (aka pancoast syndrome)

Answer 23

Ipsilateral shoulder and arm pain, paresthesias, paresis and atrophy of the thenar muscles of the hand

Question 24

Small cell lung cancer does not use the TNM staging system. Instead it is either classified as what or what disease?

Answer 24

Limited or extensive

Question 25

What hand sign is associated with lung cancer?

Answer 25

Finger clubbing?

Question 26

Pain and tenderness in which bones is a symptoms of the paraneoplastic syndrome hypertrophic pulmonary osteoarthropathy (HPOA)

Answer 26

Long bones near the adjacent joints

Question 27

A painful red line running up the leg is a paraneoplastic syndrome associated with many types of cancer?

Answer 27

Thrombophlebitis

Question 28

Hyponatraemia in lung cancer is associated with which condition?

Answer 28

SIADH (increases water retention)

Question 29

Pleural fluid in malignancy will classically look what?

Answer 29

Bloody

Question 30

Which is more rapidly progressive with early mets, NSCLC or SCLC?

Answer 30

SCLC

Question 31

What is more common, NSCLC or SCLC?

Answer 31

NSCLC

Question 32

Which is more likely to be operable, NSCLC or SCLC?

Answer 32

NSCLC